How to fix the 5 most common types of pain caused by cycling

Overcome pain and strain, stay comfortable and ride more

Cyclist riding the Trek Checkpoint SL 6 eTap gravel bike

Unless you fall off, road cycling carries a relatively low risk of injury. On the road, there’s no impact to your joints.

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But like any endurance sport, cycling can produce a catalogue of niggling aches and pains. Unless diagnosed and properly treated they can lead to something more serious.

The common-sense answer to any lasting pain is to stop what you’re doing and seek professional advice, for example from a physio.

But to give your pain a name and point you down the right road to recovery, we’ve listed the most common cycling ailments, their most likely causes, and how to go about fixing each problem.

Mountain biking is great fun but comes with its own set of risks.
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There are two main types of cycling injury, other than the flesh wounds, breaks and concussion caused by the trauma of falling off.

They’re strains and pains caused by overtraining, and injuries resulting from biomechanical stress caused by muscle imbalances or incorrect bike setup.

“It’s the root cause of pain that you need to find,” explains Barry Edwards, from Team Bath’s Physiotherapy & Sports Injury Clinic in the UK. “Stretching, massage and trigger points can alleviate symptoms, of course, but if you don’t deal with the causes, you get the same symptoms again as soon as you get back on the bike.”

Hand pain

Be careful that your grip on the bars doesn’t cause strain.
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Probable cause

Ulnar neuropathy causes a numbness or tingling sensation in the hands, commonly in the little and ring fingers.

The condition often comes about after long rides where you’ve been keeping your hands in the same position for extended periods of time.

It’s not just caused by the pressure from your weight but also the transmission of road ‘buzz’ and vibration through the bars.

Treatment

Compression or entrapment of the ulnar nerve is a cause of cycling hand pain.
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If you suffer from this, the first thing to address is your riding position to take pressure off your hands and redistribute your bodyweight more appropriately.

“More often than not, the solution is to shorten your reach,” says Edwards. “That way, more of your weight will be borne by the saddle.”

Wearing the best cycling gloves with gel padding over the ulnar area or wrapping the best handlebar tape on your bike can help remedy the issue.

There are even systems that put extra foam or gel padding along the bar tops under the tape to cushion the contact area, such as Specialized’s Body Geometry Bar Phat and Fizik’s Bar Gel.

Hip pain

Hunching forwards in an aero position contracts your hip flexors.
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Probable cause

Piriformis syndrome, also known as wallet syndrome, because of where it hurts, is often caused by overtraining and specifically by overworking the gluteus maximus muscles in your buttocks.

The piriformis is a small muscle that rotates the leg outwards. Because this isn’t a movement cyclists need to do much, the muscle can shorten and weaken.

If overstressed, it can build in size to the point of putting pressure on the sciatic nerve, causing pain or numbness down the leg or in the hip – which is why it’s a common cause of sciatica.

Treatment

Although the piriformis is a small muscle, it needs looking after.
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If this injury has been caused by an imbalance between muscles, where the underused piriformis becomes weak, the solution is fairly simple.

If you build better gluteal muscles for cycling, the tightness will ease off and often the pain will disappear too.

To stretch and strengthen your left piriformis muscle, lie on your back, bend both knees and cross your left leg over you right so that your left ankle rests on your right knee.

Relax, breathe out and then bring your right leg towards your chest by bending at the hip to stretch the piriformis.

Deepen the stretch by grabbing your right thigh with both hands and gently pulling it, and the left foot resting on it, closer to your chest.

Repeat the stretch with the other leg.

This stretch will ease tension in your piriformis muscle, helping alleviate what’s commonly known as ‘wallet syndrome’.
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Knee pain

It’s particularly hard to find the source of knee pain.
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Probable cause

Although knee pain is one of the most common areas of complaint from cyclists – followed by back and then neck – it can be difficult to diagnose.

As a cyclist, there are several common knee injuries that you can probably rule out. “Meniscus tears, and damage to the anterior and posterior cruciate ligaments, are rarely caused by cycling,” says Edwards.

These injuries are more often the result of trauma, such as a heavy fall that causes the leg to bend unnaturally, or an aggressive football tackle.

One of the most common cyclist knee complaints is pain in the kneecap.

Much cycling knee pain is caused by tautness or weakness in surrounding muscles.
Tim de Waele/Getty Images

“This is likely to be the overuse injury, patellofemoral pain syndrome or chondromalacia patellae,” says Edwards, “where the under surface of the patella becomes inflamed, usually because tightness or weakness in associated muscles moves the kneecap in a way it shouldn’t as you pedal.”

If the kneecap rubs on the bones behind it, this can irritate and inflame the cartilage at the back of the cap.

The same problem can be caused by your iliotibial (IT) band over-tightening and pulling the kneecap out of line – again causing it to rub against underlying bones.

Riding in a racing tuck on tri-bars or on the drops for extended periods doesn’t help, and pulling the knees in towards the top tube can put even more tension on your IT band, causing it to tighten.

Considering the repetitive nature of the pedalling action – up to 5,000 pedal revolutions an hour – it’s no surprise that a problem such as this can escalate quickly into a clinical injury.

You can strengthen the gluteus medius with exercises such as single-leg lifts.
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One of the most common fundamental causes of lower-body and knee pain in cyclists is a small muscle on the outside of the hip called the posterior gluteus medius.

This muscle is quite important for stabilising your hip and preventing your knees rolling inwards, and when weakened by an over-tight IT band can be the cause of many painful problems, including medial knee pain, anterior knee pain and even lower back pain.

In runners, this is one of the biggest causes of patellar tendonitis or Achilles tendon injuries.

Treatment

Hop off the bike when knee pain flares up.
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If the knee pain is acute, the first course of action is to apply what the experts call RICE – Rest, Ice, Compression and Elevation – and then get yourself to one of those experts.

“He or she will treat the swelling of the knee and release the IT band, but most importantly get to the cause of the tightness that caused the problem so that it doesn’t recur,” explains Edwards.

As with many cycling overuse injuries, your expert needs to assess you and your bike to see what’s causing the problem.

It could be poor technique, an anatomical imbalance, poor equipment choice — such as a pedal with not enough side-to-side float — or bike setup, such as incorrect saddle height.

A foam roller is a valuable injury-prevention tool.
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Foam roller exercises for cyclists are a great way to loosen a tight IT band – slowly rolling up and down your outer thigh is uncomfortable but effective.

To stretch your IT band, stand in a doorway with your right leg crossed in front of your left leg. Reach your left arm overhead towards the top right-hand corner of the doorway.

Put your right hand on your right hip and push slightly to move your hips to the left, deepening the stretch.

Hold for a few breaths, feeling the stretch along the outer torso, hip, upper thigh and knee of your left leg. Repeat on the other side.

Tension in your IT band? This is the perfect stretch to provide release.
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If you suspect a weak posterior gluteus medius muscle is the cause of your knee pain, you first need to confirm this. Here’s a simple test from Barry Edwards to find out if it needs strengthening:

Lie on your side with your legs straight and get someone to hold your uppermost foot about 12in in the air, parallel to the foot on the floor.

Relax, and then ask the helper to let your foot go.

When you try to catch and hold your leg in the air, if your outer hip muscles are weak, your foot will move forwards because the hip flexors and your knee will roll inwards as your brain recruits stronger muscles to keep your foot up, instead of using the weak posterior gluteus medius muscle.

To strengthen this little muscle, isolate it by lying on your side, with knees and hips flexed to about 70 degrees, says Edwards. “Lift the top knee off the bottom one by rotating through the hip as in the test exercise, to recruit and strengthen the posterior gluteus medius.

Other functional work will include carefully analysing your bike setup and pedal stroke, ensuring that the knee remains over the foot throughout.

“We’d also check the cleat alignment to ensure that the foot is neither toed too far in, nor too far out.”

This exercise will strengthen the posterior gluteus medius muscle.
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Stretching out your knee is also important, and this simple exercise is ideal for helping to release tension.

Lie on your side with both legs straight out below you, then gradually bend the lower leg until you feel a stretch around the knee joint.

Lying on your side with both legs straight out in front of you, gradually bend the lower leg back until the knee forms a right angle. This will help stretch out the knee joint.
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Neck pain

Alternate between riding positions to relax your shoulders and reduce neck pain.
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Probable cause

Pain caused by neck hyperextension is also normally exacerbated by positional issues on the bike, combined with lack of flexibility. “Just as you have core stabilisers around your middle,” says Edwards, “you have stabiliser muscles called deep neck flexors around your neck to hold your head up.

“When they become weak, it is left to the trapezius muscle that goes from the base of your skull to the shoulder to support your head as you lean forward.

“It’s when these stand-in muscles get fatigued that you get the aches and pains in the back and sides of your neck.”

Treatment

“To restore balance to your neck’s supporting muscles, and for a long-term solution, you need to strengthen the deep neck flexor muscles,” adds Edwards.

Here’s how: lie on your back with your head on the floor and knees bent.

Sore neck? First, lie down flat on the floor with your knees bent.
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Without moving your head at first, fix your focus on a point just above your knees, then follow your eyes with your head as if you’re nodding ‘yes’, pulling your chin in towards your throat, without lifting your head off the ground.

Hold the stretch for 10 seconds and then gently return to the start. Repeat 10 times every day.

Secondly, gradually ‘nod’ your head downwards towards your chest. You should feel the stretch up the back of your neck
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The easiest way to avoid neck pain is to change your road bike position so that you don’t have to crane your neck up so severely.

“If you’re reaching too far forwards, or your handlebars are too low,” says Edwards, “the obvious first step is to use a shorter stem to shorten your reach.”

Turning it upside down will also raise your bars, helping you ride more upright and reducing the strain you’re putting on your back and neck.

“Don’t forget to change your hand positions from the drops to the tops at regular intervals,” Edwards adds, “and sit up on the bike to stretch, straightening out your neck and back to vary the loads on the different muscle groups.”

Back pain

A stronger core can keep back pain at bay.
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Probable cause

After knees, the back is one of the biggest causes of pain for cyclists, with lack of flexibility and bad posture generally the cause.

“The natural, neutral position for the human body is standing with all your muscles in balance,” says Edwards. “So, the minute you start reaching forward, you’re stretching some of those muscles more than they are used to, and potentially holding that stretch for hours at a time.”

This over-stretches the ligaments, causing them to over-strain, which can lead to localised lower back pain, though generally with no referral of pain into the legs, according to Edwards.

A lot of time stooped over a desk and a bike is a recipe for back pain.
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This forward-bent position can also result in injuries to the trunk flexor and lumbar muscles and the sciatic nerve, while the muscle groups not involved in the movement can easily become tightened and shortened.

If you sit at a desk all day or drive lots, you’re likely to have poor posture. “That makes you even more vulnerable to back injury from over-stretching on the bike,” asserts Edwards, “putting too much pressure on the fibrous outer protective discs that protect your spinal vertebrae from shock.

“The result can be bulging discs, herniated or slipped discs, which in turn can cause sciatic nerve pain.”

Treatment

Get your workstation assessed by a physiotherapist or ergonomics expert so that your at-work posture can be the best possible.

Just as important is to take regular breaks so that you’re not sitting for hours in the same position.

“Every three-quarters of an hour, sit upright,” says Edwards, “and bend back on your chair to straighten out. Pull your shoulders back and down, working the body in as many directions as possible.”

Here are two exercises your can try:

Shrug it off

To release stress and tension from your neck and shoulders while seated at your workstation, lift your shoulders up towards your ears, squeezing them as hard as you can.

Hold for a couple of seconds and roll them back as you relax down. Repeat this eight to 10 times.

A great stretch to do when at your desk at work — just shrug your shoulders upwards, hold, then release by rolling them downwards.
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Reach for the sky

To improve your posture and stretch all the muscles in your back, sides and arms, lace your fingers together and stretch straight up towards the ceiling.

Breathe in deeply as you stretch as high as you can, then exhale and open your arms, sweeping them back in a wide arc down to your sides.

Another office-chair based stretch that will release tension in muscles throughout the back.
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As with neck problems, the easiest way to avoid back pain from over-reaching is to change your bike setup.

Raising your bars by flipping your stem or adding spacers to your headset, or choosing a shorter stem, will let you ride more upright and avoid over-stretching in the first place.

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The same goes for changing your hand positions on the bars — don’t spend all day riding on the drops, instead sit up and ride on the hoods or bar tops to give your back a break.